February 7, 2024
By: Emily DeWalt, Prevention Specialist
There is no denying that healthcare in the United States has improved over time. Advancements in public health have led to better living conditions, nutrition and sanitation. These successes, however, have not shown to benefit all populations at the same rate or to the same degree. This is what we refer to as a health disparity. According to the CDC, health disparities are defined as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” In other words, some people in the U.S. experience worse health outcomes than others, such as minority groups compared to white people. Health disparities exist between populations for chronic conditions such as heart disease and diabetes but are also present for substance use disorders. Understanding the extent of the problem, how history and biases play a role, and the issues specific to substance use is essential in order for the country to reach a state of health equity.
First, let’s take a moment to differentiate between equity and equality. The following cartoon portrays three people trying to watch a baseball game. On the equality side, each person is standing on the exact same type of box to help them watch the game. The resources they have for a better viewpoint are equal. Yet only two of the three can see over the fence. When we look at the equity panel to the right, we see that each person has a different amount of resources, but now everybody has the opportunity to watch the game. This cartoon illustrates a larger idea regarding public health: different populations need different resources in order to reach the same health outcomes. It is important to be aware of this in order to allocate resources and remove barriers to disadvantaged populations. Although this nation has made great strides, we are still in a state of inequity- health outcomes and healthcare are not equitable for all.
The United States has a long history of racism and social injustices. It has been 400 years since slavery in this country began, but its history still impacts the health of black people to this day. According to Boston University’s School of Public Health, there are patterns of poor health in the present day that match geographic outlines of where slaves were once imprisoned. We continue to see segregation throughout the country, such as with the continuation of exclusionary housing that often puts minority groups at a disadvantage for healthcare. Studies indicate that there is a strong correlation between geographical residence and health outcomes. Sadly, many people deny that history plays a role in the health status of today’s minority groups. It is likely that the people that hold this belief also have biased thoughts about certain populations.
There are two ways to categorize bias- explicit and implicit. Explicit bias is the form of bias that most people know of. The state of New York says that explicit bias is conscious and intentional, and may include attitudes, beliefs and thoughts about a particular person or group that may generalize or be hateful. This can be expressed in the form of hate speech, discrimination, or unjust and unfair treatment of these specific individuals or groups. Implicit bias, on the other hand, is unconscious and unintentional. It can be an automatic response or thought about an individual or group of people as a result of what they learned growing up. Simply viewing someone as “different,” without conscious judgement, can also create implicit biases.
We all hold implicit biases. Fortunately, there are ways to become more self-aware of these biases and work to dispel them. This is what we refer to as cultural humility, a practice that will allow us to be more culturally competent (more understanding of a culture different from your own). The program Youth in Progress recommends asking yourself the following questions when trying to make changes towards cultural humility:
Where do your biases come from and are there consequences of having this bias?
Is it harmful to someone else?
Is it based on a stereotype?
Do you think the bias is true? What evidence do you have to back up this belief?
When was the last time you experienced something like that?
When we look at substance use disorder specifically, we see the same trends for the majority of other public health issues- the problem is worse for minority populations. Not only is this seen in substance use disorder, but also mental health and overdose deaths. These outcomes can in part be attributed to a lack of a diverse health care workforce and absence of culturally informed treatment, but there many more factors at play. In future blogs, we will address the extent of substance use health disparities in the United States and the social determinants of health associated with barriers to care.
Thank you for stopping by! We appreciate you for checking out our blogs and hope you check back in for next week’s. 😊
1. Boston University School of Public Health (2019). Race, History, and the Science of Health Inequities. Last viewed January 7, 2024. Available at: https://www.bu.edu/sph/news/articles/2019/race-history-and-the-science-of-health-inequities/
2. Centers for Disease Control and Prevention (2024). Health Disparities. . Last viewed January 7, 2024. Available at: https://www.cdc.gov/healthyyouth/disparities/index.htm#:~:text=Health%20disparities%20are%20preventable%20differences,youth%20health%20risk%20behaviors%20persist
3. Kaiser Family Foundation (2022). Five Key Findings on Mental Health and Substance Use Disorders by Race/Ethnicity. Last viewed January 7, 2024. Available at: https://www.kff.org/mental-health/issue-brief/five-key-findings-on-mental-health-and-substance-use-disorders-by-race-ethnicity/
4. Youth in Progress of New York State (2024). Implicit vs Explicit Bias. Last viewed January 7, 2024. Available at: https://youthinprogress.org/resources/topics/implicit-vs-explicit-bias/
1. Children’s Minnesota (2021). Visual metaphor for equality versus equity. Implicit vs Explicit Bias. Last viewed January 7, 2024. Available at: https://www.childrensmn.org/2021/06/03/equity-not-dirty-word/
2. Destinations International (2023). Diverse population holding ways to say hello. Last viewed January 7, 2024. Available at: https://destinationsinternational.org/blog/what-cultural-competency-and-why-it-matters-your-business
3. iStock (2024). Black slave breaking free of chains. Last viewed January 7, 2024. Available at: https://www.istockphoto.com/vector/breaking-chains-african-american-hands-and-arms-gm482964331-22828335